The doctor is in (Part 3)

This week, I gave the first of two lectures on the nature and use of psychoactive medications. I began the class with an exercise that pushes students to wrestle with their presuppositions regarding the use of psychiatric medications. I asked the question, “To which of the following people would you strongly consider giving medications to, or at least refer to a physician for consideration of that option?”

Here were the brief case scenarios I mentioned:

1. A 28 year old schizophrenic man with auditory hallucinations and persecutory delusions. Most everyone in the class raised their hands to affirm their support for medication.
2. A 33 year old man who has had two periods of time in his life when he felt “jazzed,” required minimal sleep, felt invincible, was sexually promiscuous, and lost a great deal of money on impulse buying (And by the way, he has two relatives with similar problems, one of whom committed suicide.) A good proportion of the class raised their hands.
3. A 43 year old woman with profound fatigue, difficulty concentrating, insomnia, hopelessness, and suicidal ideation following the death of her teenage son six months earlier. A large number of students raised their hands, but less than with the first two examples.
4. A 34 year old man with a long history of poor job performance, multiple jobs, who has done some internet research and believes that he has adult ADHD. Many fewer students raised their hands.
5. Finally, a corporate lawyer who is noting increasing anxiety leading up to a difficult trial? No one raised his or her hand. (Tough crowd!)

Then I asked the class to consider what factors or criteria they used to decide whether someone should think about going on medication. Here were some of the answers:

• If the condition was judged to have more of a physical cause/etiology, for example, (1) and (2) especially, more students were favorable toward medication.
• If the level of acuity/danger was high, students were more likely to recommend an evaluation for medication.
• If an identifiable stressor was present to which the counselee was reacting, e.g. (5), students were less likely to lean toward medication.
• If there was a strong family history of a similar problem there was a greater openness to medication.
• If a student had encountered a similar situation in the past where medication had been helpful, he or she was more likely to choose medication. (Also true conversely, if the previous experience had been bad.)
• If the overall level of functioning was low, e.g. (1) and (3), students favored the possibility of medication.
• If the potential side effects of the medication outweighed the potential benefits, students did not choose medication.

That’s what my class said. What about you? What factors or criteria do you use when you are considering whether or not to refer a counselee for consideration of medication, in addition to your ongoing counseling?

Part three of a seven part series: Part 1 | Part 2 | Part 4 | Part 5 | Part 6 | Part 7